Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $100.06 / $100.06 / $100.06	Facility	TC	$100.06	$100.06	$100.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.88 / $76.84 / $291.39	Professional		$51.88	$76.84	$291.39
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.85 / $66.84 / $266.30	Professional	26	$28.85	$66.84	$266.30
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $27.00 / $27.00 / $59.27	Professional	52	$27.00	$27.00	$59.27
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.62 / $36.77 / $104.85	Professional	TC	$26.62	$36.77	$104.85
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $32.77 / $32.86 / $70.18	Professional		$32.77	$32.86	$70.18
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $20.83 / $47.63	Professional	26	$16.98	$20.83	$47.63
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $15.78 / $15.78 / $36.31	Professional	TC	$15.78	$15.78	$36.31
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $81.78 / $106.68 / $200.78	Professional		$81.78	$106.68	$200.78
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $44.22 / $58.57 / $110.10	Professional	26	$44.22	$58.57	$110.10
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $39.99 / $45.58 / $86.33	Professional	TC	$39.99	$45.58	$86.33
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $65.59 / $72.15 / $120.03	Professional		$65.59	$72.15	$120.03
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $34.02 / $37.42 / $62.26	Professional	26	$34.02	$37.42	$62.26
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $31.57 / $34.72 / $57.77	Professional	TC	$31.57	$34.72	$57.77
CareSource Facility/Professional Facility Modifier Low / Median / High Price $31.77 / $45.93 / $89.60	Facility		$31.77	$45.93	$89.60
CareSource Facility/Professional Professional Modifier Low / Median / High Price $31.77 / $50.45 / $88.55	Professional		$31.77	$50.45	$88.55
Cigna Facility/Professional Facility Modifier Low / Median / High Price $74.23 / $74.23 / $74.23	Facility		$74.23	$74.23	$74.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.79 / $75.43 / $131.19	Professional		$32.79	$75.43	$131.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.01 / $36.90 / $69.61	Professional	26	$17.01	$36.90	$69.61
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $15.43 / $33.15 / $66.87	Professional	TC	$15.43	$33.15	$66.87
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $74.23 / $74.23 / $74.23	Facility		$74.23	$74.23	$74.23
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $32.79 / $75.43 / $153.44	Professional		$32.79	$75.43	$153.44
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $19.17 / $53.85 / $101.56	Professional	26	$19.17	$53.85	$101.56
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $15.78 / $36.31 / $77.59	Professional	TC	$15.78	$36.31	$77.59
Molina Facility/Professional Professional Modifier Low / Median / High Price $28.15 / $46.40 / $89.50	Professional		$28.15	$46.40	$89.50
United Facility/Professional Professional Modifier Low / Median / High Price $40.67 / $67.78 / $125.31	Professional		$40.67	$67.78	$125.31
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.57 / $38.19 / $65.19	Professional	26	$21.57	$38.19	$65.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.94 / $34.40 / $62.24	Professional	TC	$18.94	$34.40	$62.24